Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$3,487.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.50
Max. Negotiated Rate	$3,124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.50
Max. Negotiated Rate	$6,455.00
Rate for Payer: Aetna Commercial	$3,873.00
Rate for Payer: Aetna Medicare Advantage	$3,873.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,292.05
Rate for Payer: Cigna Commercial	$6,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50

STENT GRAFTMASTER 3.5X19MM

Facility

$11,975.00

Hospital Charge Code	270636151
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 3.5X19MM

Facility

$11,975.00

Hospital Charge Code	270636151
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 3x19 1274419

Facility

$11,975.00

Hospital Charge Code	270636150V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 3x19 1274419

Facility

$11,975.00

Hospital Charge Code	270636150V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 4.0X19MM

Facility

$11,975.00

Hospital Charge Code	270636152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 4.0X19MM

Facility

$11,975.00

Hospital Charge Code	270636152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GR FLCY PL80x40 FTM08040

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270635691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$4,714.50
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT GR FLCY PL80x40 FTM08040

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270635691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT GR FLUY PL80x40 FTM08040

Facility

$13,570.00

Hospital Charge Code	270635691V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GR FLUY PL80x40 FTM08040

Facility

$13,570.00

Hospital Charge Code	270635691V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$3,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRFT IL 16x8.5 XRIPX1685

Facility

$11,035.00

Hospital Charge Code	270629598V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.25
Max. Negotiated Rate	$2,670.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.25

STENT GRFT IL 16x8.5 XRIPX1685

Facility

$11,036.00

Hospital Charge Code	270629598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$2,670.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

STENT GRFT IL 16x8.5 XRIPX1685

Facility

$11,036.00

Hospital Charge Code	270629598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$5,518.00
Rate for Payer: Aetna Commercial	$3,310.80
Rate for Payer: Aetna Medicare Advantage	$3,310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,814.18
Rate for Payer: Cigna Commercial	$5,518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

STENT GRFT IL 16x8.5 XRIPX1685

Facility

$11,035.00

Hospital Charge Code	270629598V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.25
Max. Negotiated Rate	$5,517.50
Rate for Payer: Aetna Commercial	$3,310.50
Rate for Payer: Aetna Medicare Advantage	$3,310.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,813.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,813.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,813.93
Rate for Payer: Cigna Commercial	$5,517.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.25

STENT GRFTMSTR 3.x19mm12744-19

Facility

$11,975.00

Hospital Charge Code	270636150
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRFTMSTR 3.x19mm12744-19

Facility

$11,975.00

Hospital Charge Code	270636150
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT HERCULINK 5X18X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644560C
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$1,125.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HERCULINK 5X18X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644560C
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$1,395.00
Rate for Payer: Aetna Medicare Advantage	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,185.75
Rate for Payer: Cigna Commercial	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HERCULINK PLUS 6x80x15mm

Facility

$4,750.00

Hospital Charge Code	270644282
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT HERCULINK PLUS 6x80x15mm

Facility

$4,750.00

Hospital Charge Code	270644282
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

Know your out-of-pocket cost for care.

All Charges